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Pharmacy and Prescription Benefits

Pharmacy services

AmeriHealth Caritas Iowa members can get pharmacy benefits. If you need medicine, your doctor will write you a prescription. Take it to one of our pharmacies.

If you can't find your regular pharmacy on this list, call Pharmacy Member Services at 1-855-332-2440. Or, call if you have questions about our pharmacies.

Copays

  Iowa Wellness Plan Medicaid hawk-i
Brand-name prescriptions $0.00 $0.00 $0.00
Generic prescription $0.00 $0.00 $0.00
Maintenance prescription $0.00 $0.00 $0.00

 

There will be no prescription copay for members who are:

  • Younger than 21 years old.
  • Receiving family planning benefits.
  • Pregnant.
  • Receiving care or residing in an institution.
    • Inpatient hospital.
    • Skilled nursing facility.
    • ICF.
    • ICF/ID.
    • State mental health institutes — except transferred resources.
  • American Indians (AI) and Alaska Natives (AN) who have received a service in an Indian Health Services (IHS) facility or clinic.

Show your AmeriHealth Caritas Iowa member ID card when you get your prescriptions. If you have questions, call Pharmacy Member Services at 1-855-332-2440.

Prescription benefits

AmeriHealth Caritas Iowa covers medicines that:

  • Are medically necessary.
  • Approved by the Food and Drug Administration (FDA).
  • Prescribed by a doctor.

Preferred drug list (list of medicines)

AmeriHealth Caritas Iowa uses the Iowa Medicaid Enterprise (IME) preferred drug list.  Your preferred drug list is the list of medicines AmeriHealth Caritas Iowa covers. This list helps your health care provider prescribe medicines for you. The preferred drug list has both generic and name brand medicines.

If a medicine is nonpreferred on the drug list or needs a prior authorization, your doctor may ask for it. They will use our prior authorization (pre-approval) process.

Call Pharmacy Member Services at 1-855-332-2440 if you have questions about the preferred drug list.

Over-the-counter medicines

We cover some generic over-the-counter medicines. You must have a prescription from a health care provider for your over-the-counter medicine. Some examples of over-the-counter medicines we may cover are:

  • Cough and cold medicines.
  • Sinus and allergy medicines.
  • Pain medicine, such as acetaminophen or ibuprofen.
  • Nicotine replacement products for quitting smoking.

Prior authorization (pre-approval)

Some medicines on the preferred drug list and all medicines not on the list need prior authorization. If your doctor writes a prescription for a medicine that needs prior authorization, they will need to send us a prior authorization request form. We will review it and let your doctor know our decision.

We will cover the medicine if it is medically necessary. If it is not, we will send you a letter that will tell you why. The letter will tell you how to appeal if you want to do so.

Emergency and 15-day initial supply

Emergency supply

Sometimes your medicine may need prior authorization, but you need to start it right away. Your pharmacy can give you a 1-time, 3-day emergency supply. Exclusions to the 3-day supply may apply.

15-day initial supply

Not all medicines work the same for everyone. To help stop waste, you may only get a 15-day supply. This will help you and your doctor make sure the medicine works for you. If it does, you may get up to a 31-day supply on your refills.

Don't wait until you run out of medicines. Get refill reminders in the member portal.